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Early fracture of the mandibular condyles may be related to an asymmetric morphologic occlusion. The aim of the study was to investigate the morphologic occlusal symmetry of non-surgically treated children after condylar fractures. The original study group consisted of 55 subjects (31 males and 24 females) who suffered temporomandibular joint condylar fractures at a young age and were treated conservatively, with physiotherapy only. Thirty-two of the respondents who were injured at a mean age of 6.5 years (range 9 months-12 years) comprised the study group. Their occlusion was re-examined intra-orally as well as on study models, at the mean age of 10.5 years (range 2.8-20.7 years). Of these, 21 suffered unilateral and 11 bilateral condylar fractures. The control group comprised a random population of 705 school children. The chi-square test was used for statistical comparison. The general distribution of occlusal patterns (Angle) differed significantly in the study group and in the controls. From the asymmetric occlusal features, only the lower midline deviation was found to be slightly more prevalent in the injured group, with almost perfect coincidence of the side of the fracture and the direction of the lower midline deviation. No significant differences were found in the distribution of posterior crossbite, anterior crossbite, and Class II subdivision in the two groups. Among children who experienced condylar fractures, a higher prevalence of malocclusion was diagnosed; the most prominent asymmetric trait was lower midline deviation coinciding with the side of the unilateral fractured condyle.

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OBJECTIVES: To evaluate the population of cleft patients treated in a Department of Orthodontics and the types of treatment modalities provided. METHODS: Demographic, cleft related and treatment related data existing in the patients' files were supplemented by questionnaires. Comparisons were conducted among 3 cleft groups: cleft lip (CL), cleft lip and palate (CLP) and cleft palate (CP). RESULTS: The response rate was 36% (n = 152). The distribution of the patients in the 3 cleft groups, the sidedness, the male predominance and association with additional anomalies were similar to the reports in the literature. Most of the patients were the 3rd born (or more) and were of normal birth weight. Consanguity in the cleft families was at least 2.5 times more prevalent than that of the Israeli population and 30% reported on additional cleft in the family. Low birth weight and additional anomalies were found mainly in the CP group. Orthodontic involvement spanned 3 developmental periods: immediate postnatal presurgical treatment, phase I between the ages 6-8 years and full orthodontic treatment at a later age. Up to the age of 5 years only one lip operation was performed for 60% of the lip-affected children and one palate operation for 65% of the palate affected patients. CONCLUSIONS: 1. The distribution of the various cleft-related parameters in this retrospective study was similar to the findings in the literature. 2. The high prevalence of additional anomalies found emphasizes the need for a thorough examination of the cleft babies. 3. Orthodontic treatment was rendered in one and two phase protocols in addition to immediate postnatal pre-surgical intervention.

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Several factors may affect the outcome of the orthodontic/surgical modality for the resolution of impacted central incisors, but particularly the manner in which the impacted tooth is exposed. The present study aimed to evaluate the post-retention clinical appearance and periodontal status of impacted maxillary central incisors which were exposed and aligned with an open-eruption surgical-orthodontic technique. Twelve subjects (four males, eight females), aged 22 years (range 15-38 years), previously treated for a unilateral impacted central incisor (ICI), were examined 10 years (range 3-25 years) post-retention. A split-mouth method was used for the comparison with the unaffected side. One treated central incisor exfoliated 10 years post-retention, thus the results were based on the remaining 11 patients. Statistically significant differences were found between the affected and control incisors in most of the periodontal parameters measured, although some were small and of minimal clinical importance. The increase in the mesio-labial pocket depth was associated with a highly significant 10 per cent reduction in bone level at this site (P = 0.007). A highly statistically significant increase in crown length (P < 0.001) and a reduction in the width of the attached gingiva (P = 0.005) were seen in these previously impacted teeth. An abnormal gingival contour was present in eight treated incisors and positional relapse in five cases. It is concluded that the convenience of the open-eruption technique must be weighed against the long-term negative aesthetic and periodontal effects on the treated tooth, although the findings of this study should be viewed with caution due to the limited sample size.

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BACKGROUND: The labiogingival notch is a developmental phenomenon affecting the maxillary central incisors. Clinically, it can be easily misdiagnosed and improperly treated. Thus, it is important for dentists to recognize this condition. CASE DESCRIPTIONS: The authors describe two cases of misdiagnosed labiogingival notch on a maxillary central incisor. In one case, the notch was misinterpreted as a carious lesion and placement of a restoration was advised. In the second case, external resorption was suspected and forced eruption of the incisor was requested. In both cases, no treatment was needed. CLINICAL IMPLICATIONS: Misdiagnosis of this developmental phenomenon may lead to unnecessary invasive interventions. Because of this, clinicians need to be aware of this clinical variant.

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Dental injury is a traumatic event related to many factors, including dentofacial morphology. In a previous study in which we used a logistic regression model, 5 cephalometric variables were defined as being the best predictors of traumatic injury. The purposes of this study were to test the predictive value of the logistic regression analysis results for the occurrence of dental injury in a new patient sample and to compare these results with the outcome based on a visual evaluation of cephalograms. The study population consisted of 2 groups of orthodontic patients: patients with injured incisors (n = 64) and patients with non-injured incisors (n = 90). Cephalometric skeletal, dental, and soft tissue measurements were made. In addition, 6 professional judges visually evaluated all cephalograms. Classification tables were constructed for the results of the logistic regression model and for the assignment of patients according to the visual evaluation of the cephalograms. The percentage of correctly classified patients at the.7 probability level was 62%. Surprisingly, the professional panel rendered an equal predictive value. The relatively inferior performance of both the mathematical model and the "eyeballing" may demonstrate that dentofacial morphology is only partially responsible for susceptibility to trauma.

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The periodontal vasculature encircling the entire length of the rat lower incisor was studied at the time of tipping movement and 3 months later. In 12 rats (212+/-4 g b.w.), loads (0.19+/-0.016 N) were applied to the lower left incisor in a linguointrusive direction. After 2 weeks of loading, six experimental animals were killed with the loading springs in place. The springs were removed in the six remaining rats, which were killed 12 weeks later. Six additional rats with intact teeth served as control. All incisors were fixed, demineralized, embedded in glycol methacrylate and cross-sectioned perpendicular to the long axis of the tooth. The distance of each section (2 microm) from the apex was calculated. A computerized image-analysis program was used to measure the width and area of the labial and lingual periodontal ligament to establish whether the measured segments corresponded to the compressed or expanded zones. In each cross-section, the various types of blood vessels were counted and the cross-sectional area of all venous vessels was measured. The results showed that after 2 weeks of loading (1) the general trend of vascular changes was similar under pressure and tension; (2) the large-diameter vessels were unaffected by loading; (3) the mean number of terminal arterioles had decreased significantly, while the number of capillaries and postcapillary venules had increased significantly in the apical tooth part; (4) the venous blood vessel area had decreased significantly in the apical tooth part; (5) the intensity of the vascular reaction was dependent on the degree of tissue distortion; and (6) after 12 weeks' recovery the vascular changes were still present, demonstrating a rebound effect. The findings suggest that microvascular alterations following tooth loading are not directly related to the spatial effect of loading itself and are of a much longer duration than expected.

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Katz's quantitative modification of Angle's occlusion classification has been found to have a high intra- and inter-examiner agreement among orthodontists. In the present study an attempt was made to introduce a 'combined' system comprising Katz's modification and overjet/overbite millimetric measurements in order to attain a more meaningful and complete classification of malocclusion than is presently available. A group of 32 raters (16 orthodontists and 16 senior-year students) examined 14 study models twice, with an interval of at least 1 month between examinations. In total, 448 x 2 determinations were performed. The percentage agreement of the Angle, the modified and the 'combined' systems, as well as the performance of the orthodontists versus the students were compared using the paired t-test. The percentage agreement obtained by both orthodontists and students was highest for Katz's modification and lowest for Angle's method. The overjet/overbite measurements affected the agreement in Katz's modified technique. The orthodontists surpassed the students with respect to Angle's method (P = 0.025), whereas no statistically significant difference existed between orthodontists and students regarding Katz's modification or the 'combined' system. It is concluded that in view of the relatively low agreement in the 'combined' method, it cannot be recommended for clinical application. The Katz's modified method, on the other hand, may be a helpful supplement to Angle's classification.

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Increased overjet and inadequate lip coverage of the maxillary incisors are considered significant risk factors in many clinical studies. The purpose of the present study was to examine this issue of dental injury by actual cephalometric measurements in orthodontic patients. Pretreatment cephalograms (taken with lips in repose) of consecutive patients were used. The patients were allotted to two groups Group T (trauma): 56 patients who had injured their maxillary incisors prior to their orthodontic treatment, mean age at the start of treatment 11.9 years (SD = 1.5); and Group C (control): 98 patients with intact maxillary incisors, mean age at the start of treatment 11.6 years (SD = 1.3). Twelve cephalometric landmarks on the soft and hard tissue profile were identified and digitized and the relevant dental, skeletal and soft tissue measurements recorded. The variables in Groups T and C were compared and their predictive values for possible occurrence of trauma were tested by logistic regression analysis. No statistically significant differences between boys and girls were found. Overjet or maxillary incisor exposure or interlabial gap, each as a single variable, could differentiate between the two groups. Logistic regression analysis indicated that only a small percentage (28.7%) of the dependent variable variation (trauma vs control) can be explained by interlabial gap, gender, upper incisor long axis to facial plane (degree), upper incisor long axis to interlabial gap and overjet.

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30 diplegic children (mean age 11.3 +/- 2.8 years old) with severe form of cerebral palsy received sirdalud monotherapy during 2-6 weeks (1 mg for children under 10 years old and 2 mg for older children, 3 times daily). Positive effects were determined in motor, autonomic and mental (emotional) spheres. Sirdalud was also very effective in patients after orthopedic-surgical treatment. Electroneuromyographic analysis showed the decrease of the synergic tonic activity, as well as the improvement of the supraspinal influences and the segmental interaction. Thus, the small doses of sirdalud are effective without side effects in children with cerebral palsy.

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OBJECTIVE: The purpose of this study was to delineate the craniofacial and dentoalveolar morphology of patients with familial dysautonomia (FD) in order to contribute to the understanding of the association between progressive sensory and autonomic neuropathy and the characteristic appearance of the dysautonomic face. PATIENTS: The study group comprised 32 patients with FD (15 females and 17 males; mean age 10.8 years, SD 3.5 years, range 5.8-19.8 years). DESIGN: Lateral cephalograms from each patient were traced twice. The means of the two measurements were compared with homologous cephalometric normal values of ethnic-specific and classical norms from the literature. RESULTS: In some parameters, the craniofacial morphology of the FD group was significantly different from the classical norms. There was a pronounced retrognathism in the mandible and a steep mandibular plane angle. The skeletal features of FD patients more closely resembled those of their ethnic group, although they were more retrognathic, and the mandibular growth axis was more horizontal. The incisors of these patients were more retropositioned and retroclined than were those of their healthy counterparts. CONCLUSIONS: The results suggest an insufficiency of the expected dentoalveolar compensatory mechanism that usually helps to bridge skeletal discrepancies. It is postulated that the neuropathy is probably the important factor in the lack of this compensatory mechanism.

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The existence of a secular trend in the distribution of occlusal patterns was studied in two generations of children. Study models and demographic data of a sample of 265 children from the previous generation (group A) and recordings of clinical examinations of 988 children from the present generation (group B) served as the data base for this study. Children in whom caries affected the occlusion and those in the deciduous dentition stage were excluded. Thus, occlusal analysis was performed for 102 children in group A and 703 in group B. A dramatic decrease was found in the prevalence of caries affecting the occlusion. No difference existed between the two groups with respect to molar and canine anteroposterior relationships. However, there was a decrease in the prevalence of normal occlusion accompanied by an increase of Class I malocclusion.

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We present the case of a 26-year-old man who at the age of 9 suffered severe trauma to both maxillary central incisors. The underlying malocclusion was skeletal and classified as dental Class II/1 with severe crowding. Both the maxillary central incisors and the two lower first premolars were extracted and the patient was treated with an edgewise appliance for 2 years. Acceptable occlusal relationships were achieved following orthodontic and adjunctive treatment which consisted of reshaping the maxillary lateral incisors with composite materials and grinding the canines to resemble lateral incisors. A critical evaluation of the esthetic and functional results at the age of 26 years is presented.

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The prevalence of occlusal features in 939 children, aged 6-13 years, belonging to an ultra-orthodox community of Jewish Ashkenazi descent living in Jerusalem was studied clinically. Sexual dimorphism was found for overjet, overbite, and habit practising. About one-quarter of the sample exhibited some degree of occlusal mutilation due to caries, thus creating a 'caries-affected' subgroup, the rest forming the 'caries-free' subgroup. In the latter set, normocclusion was scarce (7.4 per cent), Class I being the most frequent malocclusion (49.1 per cent). Caries had a significant effect on the symmetry of bilateral occlusal relationships, lower dental midline deviation, and on crowding/spacing conditions in the mixed dentition stage (except for the maxilla in late mixed dentition). The low prevalence of normocclusion can be attributed to genetic background, environmental influences and the definition attached to normal occlusion.

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Unilateral posterior crossbite (UPXB) is a common malocclusion, frequently presenting a lower midline deviation, accompanied by Class II subdivision relationships in final closure and a very high prevalence of the reverse sequencing (RS) pattern of jaw movement. These features often persist even after the elimination of the crossbite. The purpose of the present study was to examine in detail the morphologic, skeletal, and functional effects of the treatment for this malocclusion category. The experimental group consisted of 24 children in the mixed dentition stage with UPXB who were treated with removable expansion plates and a control group of 10 age-matched children with normal occlusion. Longitudinal follow-up revealed a stable dental maxillary arch expansion of at least 1.5 mm but a complete elimination of crossbite in only 50% of the cases. The frequent persistence of Class II subdivision relations and lower midline deviation that were not due to functional mandibular shift was striking. The pretreatment posteroanterior (P-A) cephalograms indicated reduced facial and maxillary widths. After treatment, the achieved maxillary width increase was greater than expected with normal growth. Longitudinal assessment of the mandibular movement response revealed by the electrognathograph showed a high prevalence of RS, which was reduced after treatment. In conclusion, (1) a higher than expected prevalence of skeletal transverse aberrations at the maxillary and zygomatic levels were found in the UPXB group; (2) the removable expansion appliance induces transverse growth of the maxilla; and (3) an inherent pattern of jaw movement is characteristic to the UPXB and does not change significantly with orthodontic treatment.

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The levels of hormones of hypothalamo-hypophyseal-adrenal system were measured in 14 10-14 year old children with infantile cerebral paralysis (ICP) with central catecholaminergic motor insufficiency. Contents of adrenocorticotropic hormone (ACTH), hydrocortisone (HC), somatotropic hormone, prolactin (P) were examined before and during Nacome administration (62.5 mg once daily in the morning). 110 patients of the same age with ICP and 18 children with acquired encephalopathy (EP) formed the control group. The elevations of ACTH, HC and P were revealed in spastic forms of ICP. Meanwhile nearly normal hormonal levels were observed in hyperkinetic forms of ICP and EP. The more pronounced effect was noted in "dopamine-dependent" children in which the drug's administration resulted in normalization of clinical and biochemical indices. Hyperkinetic phenomena revealed the connection between the character of neuromotor dyskinesias and the state of hypothalamo-hypophyseal-adrenal axis which is regulated by dopamine. The data obtained show hypofunction of dopaminergic neurotransmitter cerebral systems in patients with ICP that plays important pathogenetic role in development of disease with systemic manifestations.

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10 patients were treated with Nacom preparation (62.5 mg/daily in one dose in the morning). Both the feet support area during standing of one leg and the vertical component of support reactions were examined by the using EMED pedographic analyser (Germany-Japan). These indexes were analysed in patients before treatment, in patients treated with Nacom early--in a week after its withdrawal and after 1 months of Nacom administration. It was determined that support area of equinovarus feet was enlarged during the treatment due to the increase of the loading on the heel and the middle part of the feet. Meanwhile the support area of equinovarus feet was decreased as a consequence of loading alterations on foot inner side. The varus component of deformation turned out to be subjected most of all to Nacom action while the equinus one underwent less alterations and the valgus one has changed insignificantly. The improvement of dynamic characteristics of walking, support and pushing legs functions as well as of relations between support step periods phases was observed in all patients. The Nacom effect depended upon the type of initial feet deformation. The results obtained were explained in terms of decrease in influence of both tonic cervical reflexes and synergic tonic reactions on feet. That resulted in alterations in biomechanic and innervation components of static locomotor functions in infantile cerebral paralysis.

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Plasma catecholamine levels and serum dopamine-beta-hydrolase (D beta H) activity were investigated using high-performance chromatography and spectrophotometry, respectively, in 32 patients aged 10-14 with various motor pathology. Group 1 patients (21 children with spastic diplegia and clinical signs of central catecholaminergic neuromediation deficiency) received Nakom in a single daily dose 60 mg in the morning. The treatment produced a good clinical effect. Six children of group 2 with hereditary degenerative cerebral, spinal, nervous diseases and 5 children of group 3 with lower spastic paraplegia consequent to spinal cord trauma inflicted 6-12 months: before received Nakom in a single daily dose 30 mg in the morning for 14 days. The treatment in them resulted in an essential decrease of pelvic dysfunctions. All the children had a high DOPA level in blood plasma irrespective of the group and Nakom administration. Pretreatment dopamine (DA) levels were different: the least in cerebral palsy patients (0.019 +/- 0.01 ng/ml), the highest in group 2 (p < 0.05), in children with spinal cord pathology it was higher than normal and higher than in group 1 (p < 0.001). Nakom treatment promoted DA normalization in all the groups. Norepinephrine (NE) concentrations were very low in all the patients correlating with the degenerative process degree and did not change in response to Nakom administration. D beta H activity was inhibited in all the groups, especially in the spinal patients. Nakom increased both D beta H activity (p < 0.01) and motor activity. Thus, an increased DOPA level is plasma is not specific for nervous diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

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A chain of events in the development of the dentition following trauma is described. Shortening of the root of the lateral incisor or displacement of the tooth bud, both as a sequel to trauma, may affect the path of eruption of the adjacent canine after dental injury. Special attention should be paid to the further development and eruption of the directly and indirectly affected teeth.

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The importance of detecting maxillary canine impaction is that it may compromise dental health, particularly since a small but significant proportion of impacted canines is associated with the resorption of the roots of neighboring teeth. It has been shown that the existence of small and peg-shaped lateral incisors is highly correlated with maxillary canine palatal impaction. To date, however, it has not been established whether the root resorption that occurs has a similar correlation or a predilection for one or other types of lateral incisor crown structure. Accordingly, a group of patients with buccally or palatally impacted canines, in which root resorption of the lateral incisor could be diagnosed roentgenographically, was examined and compared with a group of cases with palatally impacted canines, none of which showed root resorption, which served as controls. The mesiodistal crown dimension of the lateral incisor in the experimental group was found to be normal in all patients except three (13%), which was significantly different from the distribution of lateral incisor size in the control group (p < 0.001). In the majority of the cases, aggressive root resorption of the lateral incisor root had occurred. We would speculate that in these cases, the normal-sized and early developing lateral incisor root obstructs the deviated eruption path of the canine and consequently stands a considerably greater chance of being damaged by resorption.

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